Consultant Cardiologist Heart West Melbourne Victoria and Senior Lecturer, NT Medical School, Flinders University, Darwin, Australia.
University of Melbourne, Melbourne, Australia.
Curr Cardiol Rep. 2019 Jul 25;21(8):87. doi: 10.1007/s11886-019-1174-0.
Coronary artery disease (CAD) is the leading contributor to cardiovascular disease; it is the most prevalent non-communicable disease globally and has high morbidity, mortality and health care cost. Risk stratification is defined as prevention or containment of disease prior to it occurring or progressing, and non-invasive surrogates include history, examination, biomarkers and non-invasive imaging. This review aims to highlight advancement in current diagnostic strategies and explores gaps for CAD secondary to atherosclerosis and non-obstructive vascular diseases.
Cardiac risk scores have largely proven inadequate in risk stratifying heterogeneous patient populations. Greater emphasis should also be provided to posttest risk stratification. Non-invasive imaging with MRI is the most accurate but least cost efficacious presently due to availability and expertise. Echocardiography and nuclear imaging have good accuracy, but radiation limits the latter. Novel echocardiographic technologies may increase its appeal. Cardiac CT angiography is increasingly promising. Non-invasive and minimally invasive imaging has significantly influenced the cost-efficacy trajectory of coronary artery disease diagnosis and management. Recent studies suggest that future guidelines will incorporate more subclassifications from the findings of these novel technologies and for more diverse patient demographics.
冠状动脉疾病（CAD）是心血管疾病的主要病因；它是全球最普遍的非传染性疾病，具有高发病率、死亡率和医疗保健费用。风险分层的定义是在疾病发生或进展之前进行预防或控制，非侵入性替代指标包括病史、检查、生物标志物和非侵入性成像。本综述旨在强调当前诊断策略的进展，并探讨动脉粥样硬化和非阻塞性血管疾病引起的 CAD 的空白。
心脏风险评分在对异质患者群体进行风险分层方面表现不佳。也应该更加重视测试后的风险分层。由于可用性和专业知识，MRI 的非侵入性成像目前是最准确但成本效益最低的。超声心动图和核成像具有良好的准确性，但辐射限制了后者。新型超声心动图技术可能会增加其吸引力。心脏 CT 血管造影术越来越有前途。非侵入性和微创性成像技术显著影响了冠状动脉疾病诊断和管理的成本效益轨迹。最近的研究表明，未来的指南将根据这些新技术的发现和更多样化的患者人群进行更多的亚分类。
